European cardiologyPub Date : 2021-09-03eCollection Date: 2021-02-01DOI: 10.15420/ecr.2021.11
Teresa Sevilla, Ana Revilla-Orodea, J Alberto San Román
{"title":"Timing of Intervention in Asymptomatic Patients with Aortic Stenosis.","authors":"Teresa Sevilla, Ana Revilla-Orodea, J Alberto San Román","doi":"10.15420/ecr.2021.11","DOIUrl":"https://doi.org/10.15420/ecr.2021.11","url":null,"abstract":"<p><p>Aortic stenosis is a very common disease. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Continuous advances in both surgical and percutaneous techniques have substantially decreased rates of perioperative complications and mortality; with this in mind, many authors suggest that earlier intervention in patients with severe aortic stenosis, when they are still asymptomatic, may be indicated. This paper summarises what is known about the natural history of severe aortic stenosis and the scientific evidence available about the optimal timing for aortic valve replacement.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e32"},"PeriodicalIF":3.0,"publicationDate":"2021-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/18/ecr-16-e32.PMC8477179.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pathophysiology and Diagnosis of Coronary Functional Abnormalities.","authors":"Jun Takahashi, Akira Suda, Kensuke Nishimiya, Shigeo Godo, Satoshi Yasuda, Hiroaki Shimokawa","doi":"10.15420/ecr.2021.23","DOIUrl":"https://doi.org/10.15420/ecr.2021.23","url":null,"abstract":"<p><p>Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary atherosclerotic stenosis. This clinical condition has recently been described as ischaemia with non-obstructive coronary arteries (INOCA). Coronary functional abnormalities are central to the pathogenesis of INOCA, including epicardial coronary spasm and coronary microvascular dysfunction composed of a variable combination of increased vasoconstrictive reactivity and/or reduced vasodilator function. During the last decade - in INOCA patients in particular - evidence for the prognostic impact of coronary functional abnormalities has accumulated and various non-invasive and invasive diagnostic techniques have enabled the evaluation of coronary vasomotor function in a comprehensive manner. In this review, the authors briefly summarise the recent advances in the understanding of pathophysiology and diagnosis of epicardial coronary artery spasm and coronary microvascular dysfunction.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e30"},"PeriodicalIF":3.0,"publicationDate":"2021-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/6e/ecr-16-e30.PMC8478147.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-07-07eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.49
Ramón Arroyo-Espliguero, María C Viana-Llamas, Alberto Silva-Obregón, Pablo Avanzas
{"title":"The Role of C-reactive Protein in Patient Risk Stratification and Treatment.","authors":"Ramón Arroyo-Espliguero, María C Viana-Llamas, Alberto Silva-Obregón, Pablo Avanzas","doi":"10.15420/ecr.2020.49","DOIUrl":"https://doi.org/10.15420/ecr.2020.49","url":null,"abstract":"<p><p>Atherosclerosis is a chronic inflammatory disease. Several circulating inflammatory markers have been proposed for clinical use due to their ability to predict future cardiovascular events and may be useful for identifying people at high risk who might benefit from specific treatment to reduce this risk. Moreover, the identification of new therapeutic targets will allow the development of drugs that can help reduce the high residual risk of recurrence of cardiovascular events in patients with coronary artery disease. The clinical benefits of reducing recurrent major cardiovascular events recently shown by canakinumab and colchicine have renewed the cardiology community's interest in inflammation as an aetiopathogenic mechanism for atherosclerosis. This review explores the use of C-reactive protein, which is the most frequently studied biomarker in this context; the concept of residual risk in primary and secondary cardiovascular prevention; and the current recommendations in international guidelines regarding the role of this inflammatory biomarker in cardiovascular risk stratification.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e28"},"PeriodicalIF":3.0,"publicationDate":"2021-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/52/ecr-16-e28.PMC8280753.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39196302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-06-18eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.45
Jack Wei Chieh Tan, Derek P Chew, David Brieger, John Eikelboom, Gilles Montalescot, Junya Ako, Byeong-Keuk Kim, David Kl Quek, Sarah J Aitken, Clara K Chow, Sok Chour, Hung Fat Tse, Upendra Kaul, Isman Firdaus, Takashi Kubo, Boon Wah Liew, Tze Tec Chong, Kenny Yk Sin, Hung-I Yeh, Wacin Buddhari, Narathip Chunhamaneewat, Faisal Hasan, Keith Aa Fox, Quang Ngoc Nguyen, Sidney Th Lo
{"title":"2020 Asian Pacific Society of Cardiology Consensus Recommendations on Antithrombotic Management for High-risk Chronic Coronary Syndrome.","authors":"Jack Wei Chieh Tan, Derek P Chew, David Brieger, John Eikelboom, Gilles Montalescot, Junya Ako, Byeong-Keuk Kim, David Kl Quek, Sarah J Aitken, Clara K Chow, Sok Chour, Hung Fat Tse, Upendra Kaul, Isman Firdaus, Takashi Kubo, Boon Wah Liew, Tze Tec Chong, Kenny Yk Sin, Hung-I Yeh, Wacin Buddhari, Narathip Chunhamaneewat, Faisal Hasan, Keith Aa Fox, Quang Ngoc Nguyen, Sidney Th Lo","doi":"10.15420/ecr.2020.45","DOIUrl":"https://doi.org/10.15420/ecr.2020.45","url":null,"abstract":"<p><p>The unique characteristics of patients with chronic coronary syndrome (CCS) in the Asia-Pacific region, heterogeneous approaches because of differences in accesses and resources and low number of patients from the Asia-Pacific region in pivotal studies, mean that international guidelines cannot be routinely applied to these populations. The Asian Pacific Society of Cardiology developed these consensus recommendations to summarise current evidence on the management of CCS and provide recommendations to assist clinicians treat patients from the region. The consensus recommendations were developed by an expert consensus panel who reviewed and appraised the available literature, with focus on data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting recommendations provide guidance on the assessment and management of bleeding and ischaemic risks in Asian CCS patients. Furthermore, the selection of long-term antithrombotic therapy is discussed, including the role of single antiplatelet therapy, dual antiplatelet therapy and dual pathway inhibition therapy.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e26"},"PeriodicalIF":3.0,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/84/ecr-16-e26.PMC8251506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ISCHEMIA Trial: What is the Message for the Interventionalist?","authors":"Emmanuel Ako, Sukhjinder Nijjer, Abtehale Al-Hussaini, Raffi Kaprielian","doi":"10.15420/ecr.2020.37","DOIUrl":"https://doi.org/10.15420/ecr.2020.37","url":null,"abstract":"","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e24"},"PeriodicalIF":3.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/21/ecr-16-e24.PMC8201464.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39238189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-05-28eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.43
Daniel Tt Chong, Felicita Andreotti, Peter Verhamme, Jamshed Dalal, Noppacharn Uaprasert, Chun-Chieh Wang, Young Keun On, Yi-Heng Li, Jun Jiang, Koji Hasegawa, Khalid Almuti, Rong Bai, Sidney Th Lo, Rungroj Krittayaphong, Lai Heng Lee, David Kl Quek, Sofian Johar, Swee-Chong Seow, Christopher J Hammett, Jack Wc Tan
{"title":"Direct Oral Anticoagulants in Asian Patients with Atrial Fibrillation: Consensus Recommendations by the Asian Pacific Society of Cardiology on Strategies for Thrombotic and Bleeding Risk Management.","authors":"Daniel Tt Chong, Felicita Andreotti, Peter Verhamme, Jamshed Dalal, Noppacharn Uaprasert, Chun-Chieh Wang, Young Keun On, Yi-Heng Li, Jun Jiang, Koji Hasegawa, Khalid Almuti, Rong Bai, Sidney Th Lo, Rungroj Krittayaphong, Lai Heng Lee, David Kl Quek, Sofian Johar, Swee-Chong Seow, Christopher J Hammett, Jack Wc Tan","doi":"10.15420/ecr.2020.43","DOIUrl":"https://doi.org/10.15420/ecr.2020.43","url":null,"abstract":"<p><p>The disease burden of AF is greater in Asia-Pacific than other areas of the world. Direct oral anticoagulants (DOACs) have emerged as effective alternatives to vitamin K antagonists (VKA) for preventing thromboembolic events in patients with AF. The Asian Pacific Society of Cardiology developed this consensus statement to guide physicians in the management of AF in Asian populations. Statements were developed by an expert consensus panel who reviewed the available data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting 17 statements provide guidance on the assessment of stroke risk of AF patients in the region, the appropriate use of DOACs in these patients, as well as the concomitant use of DOACs and antiplatelets, and the transition to DOACs from VKAs and vice versa. The periprocedural management of patients on DOAC therapy and the management of patients with bleeding while on DOACs are also discussed.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e23"},"PeriodicalIF":3.0,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/ef/ecr-16-e23.PMC8201470.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39238190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-05-21eCollection Date: 2021-02-01DOI: 10.15420/ecr.2021.07
Kevin Cheng, Ranil de Silva
{"title":"TCT Connect 2020 Trial Update: FORECAST, COMBINE OCT-FFR and DEFINE-PCI.","authors":"Kevin Cheng, Ranil de Silva","doi":"10.15420/ecr.2021.07","DOIUrl":"https://doi.org/10.15420/ecr.2021.07","url":null,"abstract":"<p><p>Recent studies reported at TCT Connect 2020 have investigated a number of open clinical questions regarding the role of coronary physiology and the assessment of plaque morphology for diagnosis (FORECAST), risk stratification (COMBINE OCT-FFR) and treatment evaluation (DEFINE-PCI) of patients with coronary artery disease. In this article, the authors provide a critical appraisal of these studies and evaluate how they add to the current evidence base for management of patients with epicardial coronary artery disease. Furthermore, they discuss their potential impact on clinical practice, limitations of these studies and unanswered clinical questions that are areas for future research.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e22"},"PeriodicalIF":3.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/04/ecr-16-e22.PMC8474051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-05-17eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.39
Giulio La Rosa, Jorge G Quintanilla, Ricardo Salgado, Juan José González-Ferrer, Victoria Cañadas-Godoy, Julián Pérez-Villacastín, Nicasio Pérez-Castellano, José Jalife, David Filgueiras-Rama
{"title":"Mapping Technologies for Catheter Ablation of Atrial Fibrillation Beyond Pulmonary Vein Isolation.","authors":"Giulio La Rosa, Jorge G Quintanilla, Ricardo Salgado, Juan José González-Ferrer, Victoria Cañadas-Godoy, Julián Pérez-Villacastín, Nicasio Pérez-Castellano, José Jalife, David Filgueiras-Rama","doi":"10.15420/ecr.2020.39","DOIUrl":"https://doi.org/10.15420/ecr.2020.39","url":null,"abstract":"<p><p>Catheter ablation remains the most effective and relatively minimally invasive therapy for rhythm control in patients with AF. Ablation has consistently shown a reduction of arrhythmia-related symptoms and significant improvement in patients' quality of life compared with medical treatment. The ablation strategy relies on a well-established anatomical approach of effective pulmonary vein isolation. Additional anatomical targets have been reported with the aim of increasing procedure success in complex substrates. However, larger ablated areas with uncertainty of targeting relevant regions for AF initiation or maintenance are not exempt from the potential risk of complications and pro-arrhythmia. Recent developments in mapping tools and computational methods for advanced signal processing during AF have reported novel strategies to identify atrial regions associated with AF maintenance. These novel tools - although mainly limited to research series - represent a significant step forward towards the understanding of complex patterns of propagation during AF and the potential achievement of patient-tailored AF ablation strategies for the near future.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e21"},"PeriodicalIF":3.0,"publicationDate":"2021-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/60/ecr-16-e21.PMC8157391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39066852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-05-17eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.50
Natalie Arnold, Katharina Lechner, Christoph Waldeyer, Michael D Shapiro, Wolfgang Koenig
{"title":"Inflammation and Cardiovascular Disease: The Future.","authors":"Natalie Arnold, Katharina Lechner, Christoph Waldeyer, Michael D Shapiro, Wolfgang Koenig","doi":"10.15420/ecr.2020.50","DOIUrl":"https://doi.org/10.15420/ecr.2020.50","url":null,"abstract":"<p><p>Despite considerable advances in reducing the global burden of atherosclerotic cardiovascular disease by targeting conventional risk factors, significant residual risk remains, with low-grade inflammation being one of the strongest risk modifiers. Inflammatory processes within the arterial wall or systemic circulation, which are driven in a large part by modified lipoproteins but subsequently trigger a hypercoagulable state, are a hallmark of atherosclerotic cardiovascular disease and, in particular, its clinical complications. Extending conventional guideline-based clinical risk stratification algorithms by adding biomarkers of inflammation may refine phenotypic screening, improve risk stratification and guide treatment eligibility in cardiovascular disease prevention. The integration of interventions aimed at lowering the inflammatory burden, alone or in combination with aggressive lipid-modifying or even antithrombotic agents, for those at high cardiovascular risk may hold the potential to reduce the still substantial burden of cardiometabolic disease. This review provides perspectives on future clinical research in atherosclerosis addressing the tight interplay between inflammation, lipid metabolism and thrombosis, and its translation into clinical practice.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e20"},"PeriodicalIF":3.0,"publicationDate":"2021-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/38/ecr-16-e20.PMC8157394.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39066851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
European cardiologyPub Date : 2021-05-13eCollection Date: 2021-02-01DOI: 10.15420/ecr.2020.44
Anne Mirjam Kerola, Silvia Rollefstad, Anne Grete Semb
{"title":"Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment.","authors":"Anne Mirjam Kerola, Silvia Rollefstad, Anne Grete Semb","doi":"10.15420/ecr.2020.44","DOIUrl":"https://doi.org/10.15420/ecr.2020.44","url":null,"abstract":"<p><p>Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.</p>","PeriodicalId":93994,"journal":{"name":"European cardiology","volume":" ","pages":"e18"},"PeriodicalIF":3.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/c3/ecr-16-e18.PMC8145075.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39036431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}